Young People Consent Form - All Saints Church Dedworth

Thanks for taking the time to fill in this form. In line with our Safeguarging policies, we need to have some information about you and your young person before they will be allowed to stay at Youth Cafe. Please fill this in carefully, and ensure you give consent at the bottom before submitting.

Adult: Name *

First name & Surname of responsible aduit

Home Address *

Address including postcode

Adult Phone Number *

Emergency contact number

Young Person: Name *

First name and Surname

Young Persons: Date of Birth *

Young Person: Phone Number

Include if they have one.

Contacting Young Person by Mobile Phone – select all that apply to give consent

In event of emergency
In relation to youth events
allowed to be added to a group chat with leaders & other young people

By ticking the above, I give consent to contact the young person by mobile phone.

Additional Information

Doctors Surgery: Name *

Name of doctors surgery

Doctors Surgery: Address *

Address including postcode

Doctors Surgery: Phone Number *

CONSENT *

by ticking this box, I give consent for the Young person listed above to attend the Youth Cafe at All Saints Church Dedworth….

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